Dj Le 250A Form PDF Details

In the ever-evolving landscape of legal documentation and requests, the DJ-LE-250A form stands out as a critical tool for conducting background checks in the State of Wisconsin. Issued by the Department of Justice, this form facilitates the process of requesting criminal history records on multiple individuals simultaneously, a task that is becoming increasingly necessary for a variety of reasons, from employment screening to housing applications. The form is designed to accommodate requests from different types of requestors, including governmental agencies, nonprofit organizations, and members of the general public, indicating a broad utility scope. It outlines specific instructions for filling out and submitting requests, which include providing detailed information about the individuals being checked and the purpose behind the request. Additionally, it delineates the financial obligations that come with such requests, highlighting the fees involved and the additional charges for certain types of checks, like those for caregivers, which require more extensive screening. Understanding and adhering to these detailed instructions ensure the process is conducted efficiently, with the Department of Justice also mandating the inclusion of a self-addressed, postage-paid envelope to facilitate the return of information. The form, therefore, represents a crucial intersection between the legal requirements for accessing public records and the practical needs of various entities in safeguarding their communities and interests.

QuestionAnswer
Form NameDj Le 250A Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdjle250a dj namerecord online form

Form Preview Example

DJ-LE-250A (Rev. 1/21)

STATE OF WISCONSIN

DEPARTMENT OF JUSTICE



DIVISION OF LAW ENFORCEMENT SERVICES

Crime Information Bureau

Record Check Unit

WISCONSIN CRIMINAL HISTORY

MULTIPLE NAME RECORD REQUEST

PO Box 2688

Madison, WI 53701-2688 608/266-7314

A self-addressed, postage-paid envelope must accompany every inquiry. Ensure sufficient postage is included. See next page for more information/instructions.

Return request

 

 

 

 

 

 

 

To :

__________________________________________ Attn: ____________________________

Phone: _____________________________

Street:

______________________________________________________________________________

FAX:

_____________________________

City, State,

 

 

 

 

 

 

 

Zip:

____________________________________________________________________ E-mail: _______________________________________

Requestor Type Check One

Request Purpose - Check One

Total Number of

 

Payment Type Check One

Government Agency$12.00*

General Information

Requests Submitted

Bill Account

General Public

$12.00*

Public Housing

 

 

 

 

Number #____________

Nonprofit Org.

$12.00*

Caregiver – General (*Add $3 DHS fee)

 

 

 

 

Amount

Public Defender (Fee Exempt)

Child Day Care - Caregiver (*Add $3 DHS fee)

 

 

 

 

Enclosed $____________

 

 

 

 

SPD # _______________________

Provide either Facility # _____________

Multiply the Search Fee (including DHS fee) times

 

 

 

or Certifying Agency # ______________

the Number of Requests to determine the amount to enclose

* Last Name

* First Name

Middle

* Sex * Race

*Date of Birth

(MM/DD/YYYY)

Other Identifying Data

(Soc Sec Num, Maiden name)

**CIB Use Only

(Leave Blank)

*Required Data – Please type or print legibly

**CIB will indicate “No Record” or will record the State Identification Number of the corresponding record in this column. The record(s) will be attached to this form and returned.

General Instructions

Use form DJ-LE-250A to request criminal background checks on more than one individual. Use form DJ-LE-250 to request background checks on a single individual. Wisconsin Statutes 19.35(1) and

165.82provide that any person or entity may request a criminal background check. The subject of the inquiry may be any person. Wisconsin adult criminal history data held by the Crime Information Bureau is public information. Wisconsin does not release juvenile information unless statutorily authorized.

The Wisconsin Criminal History Record Request must provide:

(1)Complete the “Return request to” section.

(2)Requestor Type. Check the box for your requestor type. Nonprofit organizations must include a copy of your 501(c)3 from the IRS.. Public defenders must include your SPD number.

(3)Request Purpose. Check the “General Information” box unless you need the special processing described below. Requests received without a purpose checked will be processed as General. Caregiver Background Check processing should be used by entities or individuals required to do caregiver background checks under s. 50.065, and child care entities under s. 48.685. The caregiver background check includes a Wisconsin criminal background check, a license and registry check from the Wisconsin Department of Health Services (DHS) and a professional credential check from the Wisconsin Department of Regulation and Licensing (DRL). The results of the caregiver background check from DHS/DRL are returned separately from the Wisconsin criminal history results. Child day care providers with day care facility numbers (assigned by the Division of Children and Families (DCF)) or with certifying agency numbers (assigned by the Wisconsin Department of Workforce Development (DWD)) must check the “Child Day Care” box and provide their facility or agency number. All other entities and individuals covered by the Caregiver legislation must check the “Caregiver Background Check – General” box.

(4)Enter the number of requests.

(5)Payment Type. Wisconsin s. 165.82 requires CIB to charge a fee for background checks. If you have an account and wish to be billed, enter your account number. Account customers will be billed monthly. A check or money order must accompany all other requests. Multiply the fee amount times the number of requests to determine the amount to enclose. If appropriate, include DHS Caregiver fee in Amount Enclosed. Make checks payable to the Wisconsin Department of Justice.

(6)Enter the complete name, sex, race, and date of birth for each individual being checked. Entry of social security number is optional, but please be aware that this number is one of the unique identifiers used by the Crime Information Bureau and by the Department of Health Services. Social Security numbers help prevent incorrect matches.

(7)A self-addressed, postage-paid envelope must accompany every inquiry. Ensure sufficient postage is included. This form will be returned and stamped “No Record” if there is no public criminal information on file at CIB. The form will be accompanied by public criminal history information if a record is found. Please allow 10 business days for the CIB record check and reasonable mailing time by the postal service. Do not provide an additional envelope for Caregiver results. General Caregiver results will be returned to the address specified in the “Return request to” section and Child Daycare results will be returned to the address on file at DHS or DWD.

Mail requests to:

Crime Information Bureau, Attn: Record Check Unit, PO Box 2688, Madison, WI 53701-2688

165.82CRIMINAL HISTORY SEARCH FEE. (1) Notwithstanding ss. 19.35(3) the Department of Justice shall impose the following fees, plus any surcharge required under sub. (1m), for criminal history searches for purposes unrelated to criminal justice:

(a)For each record check, except a fingerprint card record check, requested by a nonprofit organization, $7.00.

(ag) For each record check, except a fingerprint card record check, requested by a governmental agency, $7.00. (ar) For each fingerprint card record check requested by a governmental agency, $15.

(b) For each record check by any other requestor, $7.00.

(1m) The Department of Justice shall impose a $5 surcharge if a person requests a paper copy of a criminal history search requested under sub. (1).

(2)The Department of Justice shall not impose fees for criminal history searches for purposes related to criminal justice.

1999 WISCONSIN ACT 9 This act authorizes the Department of Health Services to impose a fee for caregiver checks submitted to that agency. This fee has been set at $3 and is effective April 1, 2000. The Department of Justice has agreed to collect this fee for DHS.

Requestor Type Category Definitions

Nonprofit Organization – An organization in which no part of the income is distributable to its members, directors or officers. Record check requests submitted to the Crime Information Bureau by nonprofit organizations must include a copy of their 501{c}{3} ruling from the Internal Revenue Service.

Governmental Agency – A federal, state, county or municipal governing body created by constitution, state, code, charter, ordinance, rule or order and any formally constituted subunit or agency thereof. This category includes public school districts.

Any Other Requestor – Includes the general public, and individual, agency or organization that does not meet the definition of governmental agency, nonprofit organization or a criminal justice agency involved in the administration of criminal justice.

How to Edit Dj Le 250A Form Online for Free

It really is a breeze to fill out the Dj Le 250A Form. Our PDF tool was intended to be easy-to-use and allow you to prepare any PDF efficiently. These are the basic steps to take:

Step 1: Hit the orange button "Get Form Here" on this webpage.

Step 2: Now you will be within the form edit page. You can include, enhance, highlight, check, cross, insert or delete fields or words.

Please provide the next details to fill out the Dj Le 250A Form PDF:

step 1 to completing Dj Le 250A Form

You have to type in the necessary details in the Required Data Please type or, and CIB will indicate No Record or field.

Filling in Dj Le 250A Form stage 2

Step 3: The moment you hit the Done button, your completed file is simply exportable to all of your devices. Alternatively, you will be able to deliver it by means of mail.

Step 4: It may be easier to keep duplicates of your file. You can be sure that we will not publish or see your data.

Watch Dj Le 250A Form Video Instruction

Please rate Dj Le 250A Form

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .